Black men who have sex with men (BMSM) continue to be disproportionately affected by HIV. Methamphetamine use has been identified as a source of HIV risk in gay and bisexually identified men, yet the relationship between methamphetamine use and sexual risk among BMSM specifically remains unclear. The goal of this mixed-methods dissertation was to investigate psychological, contextual, and developmental factors informing methamphetamine use and HIV risk behavior among a sample of heterosexual, gay, and bisexual BMSM (N = 52) in New York City. Additionally, patterns of methamphetamine use and sources for purchasing methamphetamine were also examined. Participants reported using multiple substances and used, on average, nine days in the last 30 days. They spent an average of US$159 per month on methamphetamine and a median of US$398 on all substances. Frequency of monthly methamphetamine use was related to the use of powdered cocaine and alcohol use, but not to the use of other substances. Participants primarily used in private venues, such as at home or in the homes of friends and reported obtaining methamphetamine from multiple sources. Men who reported exchanging sex for methamphetamine reported greater use in public venues, such as sex clubs, sex parties, and circuit parties. Methamphetamine use and sexual risk were associated with stress induced by stigmatization arising from and within larger dominant White gay culture, stigmatization incurred within the Black community, internalized homophobia, and stress induced by living under the shadow of the perceived inevitability of contracting HIV as BMSM. Finally, participants shared information on methamphetamine treatment strategies they felt would be successful with BMSM. These included (1) culturally-appropriate outreach/recruitment strategies, (2) therapist qualities, (3) group characteristics, and (4) intervention elements themselves. Given the history of marginalization and stigmatization faced by BMSM, findings gathered here and through literature review suggest the importance of tailoring interventions to the specific needs of BMSM, instead of employing a one-size-fits-all model.